Substance-Related Disorders

Substance-Related Disorders
Chapter 12

What is a drug? Any substance other than food that affects our bodies or minds Need not be a medicine or illegal Current language uses the term “substance” rather than “drug” to overtly include alcohol, tobacco, and caffeine Comer, Abnormal Psychology, 7e

Substances may cause temporary changes in behavior, emotion, or thought May result in substance intoxication (literally, “poisoning”), a temporary state of poor judgment, mood changes irritability, slurred speech, and poor coordination Some substances such as LSD may produce a particular form of intoxication, sometimes called hallucinosis, which consists of perceptual distortions and hallucinations Comer, Abnormal Psychology, 7e

Substances can also produce long-term problems: Substance abuse: a pattern of behavior in which a person relies on a drug excessively and chronically, damaging relationships, affecting work functioning, and/or putting self or others in danger Substance dependence: a more advanced pattern of use in which a person abuses a drug and centers his or her life around it Also called “addiction” May include tolerance (need increasing doses to get an effect) and withdrawal (unpleasant and dangerous symptoms when substance use is stopped or cut down) Comer, Abnormal Psychology, 7e

About 10% of all teens and adults in the U.S. display substance abuse or dependence The highest rates of substance abuse or dependence in the U.S. is found among Native Americans (19%), while the lowest is among Asian Americans (4.3%) White Americans, Hispanic Americans, and African Americans display rates between 9 and 10% Only 26% receive treatment Comer, Abnormal Psychology, 7e

Many drugs are available in our society Some are naturally occurring; others are produced in a laboratory Some require a physician’s prescription for legal use; others, like alcohol and nicotine, are legally available to adults Still others, like heroin, are illegal under all circumstances Comer, Abnormal Psychology, 7e

Recent statistics suggest that drug use is a significant social problem 28 million people in the U.S. have used an illegal substance within the past year 20.4 million are using one of them currently Almost 22% of all high school seniors have used an illegal drug within the past month Comer, Abnormal Psychology, 7e

There are several categories of substances used and studied: Depressants Stimulants Hallucinogens Cannabis Polydrug use Comer, Abnormal Psychology, 7e

Comer, Abnormal Psychology, 7e
Depressants Depressants slow the activity of the central nervous system (CNS) Reduce tension and inhibitions May interfere with judgment, motor activity, and concentration Three most widely used depressants: Alcohol Sedative-hypnotic drugs Opioids Comer, Abnormal Psychology, 7e

Depressants: Alcohol The World Health Organization estimates that 2 billion people worldwide consume alcohol In the U.S., more than half of all residents drink alcoholic beverages from time to time Comer, Abnormal Psychology, 7e

Depressants: Alcohol When people consume 5 or more drinks in a single occasion, it is called a binge-drinking episode 23% of all people in the U.S. over the age of 11 binge-drink each month Men account for 81% of binge-drinking episodes Nearly 7% of people over age the age of 11 are heavy drinkers, having 5 drinks on at least 5 occasions per month Among heavy drinkers, the ratio of men to women is 4:1 (around 8% to 4%) Comer, Abnormal Psychology, 7e

Depressants: Alcohol All alcoholic beverages contain ethyl alcohol It is absorbed into the blood through the stomach lining and takes effect in the bloodstream and CNS Short-term: alcohol blocks messages between neurons Alcohol helps GABA (an inhibitory messenger) shut down neurons and “relax” the drinker Comer, Abnormal Psychology, 7e

Depressants: Alcohol The first brain area affected is that which controls judgment and inhibition Next affected are additional areas in the CNS, leaving the drinker even less able to make sound judgments, speak clearly, and remember well Motor difficulties increase as drinking continues, and reaction times slow Comer, Abnormal Psychology, 7e

Depressants: Alcohol The extent of the effect of ethyl alcohol is determined by its concentration (proportion) in the blood A given amount of alcohol has a lesser effect on a large person than on a small one Gender also affects blood alcohol concentration Women have less alcohol dehydrogenase, an enzyme in the stomach that metabolizes alcohol before it enters the blood Women become more intoxicated than men on equal doses of alcohol Comer, Abnormal Psychology, 7e

Depressants: Alcohol Levels of impairment are closely tied to the concentration of ethyl alcohol in the blood: BAC = 0.06: Relaxation and comfort BAC = 0.09: Intoxication BAC > 0.55: Death Most people lose consciousness before they can drink this much Comer, Abnormal Psychology, 7e

Depressants: Alcohol The effects of alcohol subside only after alcohol is metabolized by the liver The average rate of this metabolism is 25% of an ounce per hour You can’t increase the speed of this process! Comer, Abnormal Psychology, 7e

Depressants: Alcohol Though legal, alcohol is one of the most dangerous recreational drugs Its effects can extend across the life span Alcohol use is a major problem in high school, college, and adulthood Comer, Abnormal Psychology, 7e

Depressants: Alcohol In any given year, 6.6% of the world’s population will fall into a pattern of abuse or dependence 13.2% experience one of the patterns sometime during their life 7.6% of all adults in the U.S. (almost 19 million people) display an alcohol use disorder In their lifetime, between 9% and 18% of adults will display one of these patterns, with men outnumbering women 2:1 Comer, Abnormal Psychology, 7e

Depressants: Alcohol The prevalence of alcoholism in a given year is about the same (7% to 9%) for White Americans, African Americans and Hispanic Americans The men in these groups show strikingly different age patterns Comer, Abnormal Psychology, 7e

Depressants: Alcohol Generally, Asians have lower rates of alcohol disorders than do people from other cultures As many as one-half of these individuals have a deficiency of alcohol dehydrogenase; thus, they have a negative reaction to even modest alcohol use Comer, Abnormal Psychology, 7e

Depressants: Alcohol Alcohol abuse In general, people who abuse alcohol drink large amounts regularly and rely on it to enable them to do things that would otherwise make them anxious Eventually the drinking interferes with work and social functioning Individual patterns of alcohol abuse vary Comer, Abnormal Psychology, 7e

Depressants: Alcohol Alcohol dependence For many people, the pattern of alcohol misuse includes dependence They build up a physiological tolerance and need to drink greater amounts to feel its effect They may experience withdrawal, including nausea and vomiting, when they stop drinking A small percentage of alcohol-dependent people experience a dramatic and dangerous withdrawal syndrome known as delirium tremens (“the DTs”) Can be fatal! Comer, Abnormal Psychology, 7e

Depressants: Alcohol What is the personal and social impact of alcoholism? Alcoholism destroys families, social relationships, and careers Losses to society total many billions of dollars annually Plays a role in suicides, homicides, assaults, rapes, and accidents Has serious effects on the children (some 30 million) of alcoholic parents Comer, Abnormal Psychology, 7e

Depressants: Alcohol What is the personal and social impact of alcoholism? Long-term excessive drinking can seriously damage physical health Especially damaged is the liver (cirrhosis) Long-term excessive drinking can cause major nutritional problems Example: Korsakoff’s syndrome Women who drink alcohol during pregnancy place their fetuses at risk from fetal alcohol syndrome (FAS) Comer, Abnormal Psychology, 7e

Depressants: Sedative-Hypnotic Drugs
Sedative-hypnotic (anxiolytic) drugs produce feelings of relaxation and drowsiness At low doses, they have a calming or sedative effect At high doses, they function as sleep inducers or hypnotics Sedative-hypnotic drugs include barbiturates and benzodiazepines Comer, Abnormal Psychology, 7e

Sedative-Hypnotic Drugs: Barbiturates
First discovered in the late 19th century, barbiturates were widely prescribed in the first half of the 20th century to fight anxiety and to help people sleep Although still prescribed, they have been largely replaced by benzodiazepines They can cause many problems, not the least of which are abuse, dependence, and overdose Comer, Abnormal Psychology, 7e

Barbiturates are usually taken in pill or capsule form At low doses, they reduce anxiety in a manner similar to alcohol by attaching to the GABA receptors and helping GABA operate Also similar to alcohol, barbiturates are metabolized by the liver Comer, Abnormal Psychology, 7e

At high doses, barbiturates affect the reticular formation in the brain (the “awake” center), causing people to get sleepy At too high a level, they can halt breathing, lower blood pressure, and can lead to coma and cause death Comer, Abnormal Psychology, 7e

Repeated use of barbiturates can quickly result in a pattern of abuse and/or dependence A great danger of barbiturate dependence is that the lethal dose of the drug remains the same, even while the body is building a tolerance for the sedative effects Barbiturate withdrawal is particularly dangerous because it can lead to convulsions Comer, Abnormal Psychology, 7e

Sedative-Hypnotic Drugs: Benzodiazepines
Benzodiazepines are often prescribed to relieve anxiety Most popular sedative-hypnotics available Class includes Xanax, Ativan, and Valium Comer, Abnormal Psychology, 7e

Benzodiazepines have a depressant effect on the CNS by binding to GABA receptors and increasing GABA activity Unlike barbiturates and alcohol, however, benzodiazepines relieve anxiety without causing related drowsiness As a result, they are less likely to slow breathing and lead to death by overdose Comer, Abnormal Psychology, 7e

Once thought to be a safe alternative to other sedative-hypnotic drugs, benzodiazepines can cause intoxication and lead to abuse and dependence As many as 1% of U.S. adults abuse or become physically dependent on benzodiazepines at some point in their lives Comer, Abnormal Psychology, 7e

Depressants: Opioids This class of drug includes both natural (opium, heroin, morphine, codeine) and synthetic (methadone) compounds and is known collectively as “narcotics” Each drug has a different strength, speed of action, and tolerance level Comer, Abnormal Psychology, 7e

Depressants: Opioids Narcotics are smoked, inhaled, injected by needle just under the skin (“skin popped”), or injected directly into the bloodstream (“mainlined”) Injection seems to be the most common method of use, although other techniques have been increasing in recent years An injection quickly brings on a “rush”: a spasm of warmth and ecstasy that is sometimes compared with orgasm This spasm is followed by several hours of pleasurable feelings (called a “high” or “nod”) Comer, Abnormal Psychology, 7e

Depressants: Opioids These drugs, provide pain relief and relaxation by depressing the CNS Opioids bind to the receptors in the brain that ordinarily receive endorphins (NTs that naturally help relieve pain and decrease emotional tension) When these sites receive opioids, they produce pleasurable and calming feelings, just as endorphins do In addition to reducing tension, opioids can cause nausea, narrowing of the pupils, and constipation Comer, Abnormal Psychology, 7e

Depressants: Opioids Heroin abuse and dependence Heroin use exemplifies the problems posed by opioids: After just a few weeks, users may become caught in a pattern of abuse (and often dependence) Users quickly build a tolerance for the drug and experience withdrawal when they stop taking it Early withdrawal symptoms include anxiety and restlessness; later symptoms include twitching, aches, fever, vomiting, diarrhea, and weight loss from dehydration Comer, Abnormal Psychology, 7e

Depressants: Opioids Heroin abuse and dependence People who are dependent on heroin soon need the drug to avoid experiencing withdrawal, and they must continually increase their doses in order to achieve even that relief Many users must turn to criminal activity to support their “habit” and avoid withdrawal symptoms Comer, Abnormal Psychology, 7e

Depressants: Opioids Heroin abuse and dependence Surveys suggest that close to 1% of adults in the U.S. become addicted to heroin or other opioids at some point in their lives Comer, Abnormal Psychology, 7e

Depressants: Opioids What are the dangers of heroin abuse? The most immediate danger is overdose The drug closes down the respiratory center in the brain, paralyzing breathing and causing death Death is particularly likely during sleep Ignorance of tolerance is also a problem About 2% of those dependent on heroin and other opioids die under the influence of the drug each year Users run the risk of getting impure drugs Opioids are often “cut” with noxious chemicals Dirty needles and other equipment can spread infection Comer, Abnormal Psychology, 7e

Stimulants Stimulants are substances that increase the activity of the central nervous system (CNS) Cause increases in blood pressure, heart rate, and alertness Cause rapid behavior and thinking The four most common stimulants are: Cocaine Amphetamines Caffeine Nicotine Comer, Abnormal Psychology, 7e

Stimulants: Cocaine Derived from the leaves of the coca plant, cocaine is the most powerful natural stimulant known 28 million people in the U.S. have tried cocaine 2.4 million people are currently using it Comer, Abnormal Psychology, 7e

Stimulants: Cocaine Cocaine produces a euphoric rush of well-being It stimulates the CNS and decreases appetite It seems to work by increasing dopamine at key receptors in the brain by preventing the neurons that release it from reabsorbing it Also appears to increase norepinephrine and serotonin Comer, Abnormal Psychology, 7e

Stimulants: Cocaine High doses of cocaine can produce cocaine intoxication, whose symptoms include mania, paranoia, and impaired judgment Some people also experience hallucinations and/or delusions, a condition known as cocaine-induced psychotic disorder As the stimulant effects of the drug subside, the user experiences a depression-like letdown, popularly called “crashing” Comer, Abnormal Psychology, 7e

Stimulants: Cocaine Cocaine abuse and dependence Regular use may lead to a pattern of abuse in which the person remains under the effect of cocaine for much of each day and functions poorly in major areas of life Dependence on the drug may also develop Currently, close to 1% of all people in the U.S. manifest cocaine abuse or dependence Comer, Abnormal Psychology, 7e

Stimulants: Cocaine Cocaine abuse and dependence Cocaine use in the past was limited by the drug’s high cost Since 1984, cheaper versions of the drug have become available, including: A “freebase” form where the drug is heated and inhaled with a pipe “Crack,” a powerful form of freebase that has been boiled down for smoking in a pipe Comer, Abnormal Psychology, 7e

Stimulants: Cocaine What are the dangers of cocaine? Aside from its behavioral effects, cocaine poses significant physical danger Pregnant women who use cocaine have an increased likelihood of miscarriage and of having children with abnormalities The greatest danger of use is the risk of overdose Excessive doses depress the brain’s respiratory function, and stop breathing Cocaine use can also cause heart failure Comer, Abnormal Psychology, 7e

Stimulants: Amphetamines
Amphetamines are stimulant drugs that are manufactured in the laboratory Methamphetamine, in particular, has had a surge in popularity in recent years Most often taken in pill or capsule form Can be injected or taken in “ice” and “crank” form, counterparts of freebase cocaine and crack Comer, Abnormal Psychology, 7e

Like cocaine, amphetamines: Increase energy and alertness and lower appetite when taken in small doses Produce a rush, intoxication, and psychosis in high doses Cause an emotional letdown as they leave the body Comer, Abnormal Psychology, 7e

Also like cocaine, amphetamines stimulate the CNS by increasing dopamine, norepinephrine, and serotonin Tolerance develops quickly, so users are at great risk of becoming dependent When people dependent on the drug stop taking it, serious depression and extended sleep follow Approximately 1.5% to 2% of Americans become dependent on amphetamines at some point in their lives Comer, Abnormal Psychology, 7e

Stimulants: Caffeine Caffeine is the world’s most widely used stimulant Around 80% of the world’s population consume it daily Most consumption is in the form of coffee; the rest is in the form of tea, cola, energy drinks, chocolate, and over-the-counter medications Around 99% of ingested caffeine is absorbed by the body and reaches its peak concentration within an hour Comer, Abnormal Psychology, 7e

Stimulants: Caffeine Caffeine acts as a stimulant in the CNS, producing a release of dopamine, serotonin, and norepinephrine in the brain More than 2 to 3 cups of brewed coffee can lead to caffeine intoxication Seizures and respiratory failure can occur at doses greater than 10 grams of caffeine (about 100 cups of coffee) Comer, Abnormal Psychology, 7e

Stimulants: Caffeine Many people who suddenly stop or cut back their usual intake experience withdrawal symptoms, including headaches, depression, anxiety, and fatigue High doses of caffeine during pregnancy increase the risk of miscarriage Comer, Abnormal Psychology, 7e

Hallucinogens, Cannabis, and Combinations of Substances
Other kinds of substances can cause problems for users and for society Hallucinogens Produce delusions, hallucinations, and other sensory changes Cannabis substances Produce sensory changes, but have both depressant and stimulant effects Combinations of substances = polysubstance use Comer, Abnormal Psychology, 7e

Hallucinogens Hallucinogens, also known as psychedelic drugs, produce powerful changes in sensory perceptions (sometimes called “trips”) Include natural hallucinogens Mescaline Psilocybin And synthetic hallucinogens Lysergic acid diethylamide (LSD) MDMA (Ecstasy) Comer, Abnormal Psychology, 7e

Hallucinogens LSD is one of the most famous and powerful hallucinogens Within two hours of being ingested, it brings on a state of hallucinogen intoxication (hallucinosis) Increased and altered sensory perception Hallucinations may occur The drug may cause different senses to cross, an effect called synesthesia May produce extremely strong emotions May have some physical effects Effects wear off in about six hours Comer, Abnormal Psychology, 7e

Hallucinogens Hallucinogens appear to produce these symptoms by binding to serotonin receptors These receptors control visual information and emotions, thereby causing the various effects of the drug on the user Comer, Abnormal Psychology, 7e

Hallucinogens More than 14% of Americans have used hallucinogens at some point in their lives Tolerance and withdrawal are rare But the drugs do pose physical dangers Users may experience a “bad trip” – the experience of enormous unpleasant perceptual, emotional, and behavioral reactions Another danger is the risk of “flashbacks” Can occur a year or more after last drug use Comer, Abnormal Psychology, 7e

Cannabis The drugs produced from varieties of the hemp plant are, as a group, called cannabis They include: Hashish, the solidified resin of the cannabis plant Marijuana, a mixture of buds, crushed leaves, and flowering tops The major active ingredient in cannabis is tetrahydrocannabinol (THC) The greater the THC content, the more powerful the drug Comer, Abnormal Psychology, 7e

Cannabis When smoked, cannabis produces a mixture of hallucinogenic, depressant, and stimulant effects At low doses, the user feels joy and relaxation May become anxious, suspicious, or irritated This overall “high” is technically called cannabis intoxication At high doses, cannabis produces odd visual experiences, changes in body image, and hallucinations Most of the effects of cannabis last 3 to 6 hours Mood changes may continue longer Comer, Abnormal Psychology, 7e

Cannabis Marijuana abuse and dependence Marijuana was once thought not to cause abuse or dependence Today many users are caught in a pattern of abuse Some users develop tolerance and withdrawal, experiencing flu-like symptoms, restlessness, and irritability when drug use is stopped About 2% of people in the U.S. displayed marijuana abuse or dependence in the past year About 5% will fall into these patterns at some point in their lives Comer, Abnormal Psychology, 7e

Cannabis Marijuana abuse and dependence One theory about the increase in abuse and dependence is the change in the drug itself The marijuana available today is significantly more potent than the drug used in the late 1960s Comer, Abnormal Psychology, 7e

Cannabis Is marijuana dangerous? As the strength and use of the drug has increased, so have the risks of using it May cause panic reactions similar to those caused by hallucinogens Because of its sensorimotor effects, marijuana has been implicated in accidents Marijuana use has been linked to poor concentration and impaired memory Comer, Abnormal Psychology, 7e

Cannabis Is marijuana dangerous? Long-term use poses additional dangers May cause respiratory problems and lung cancer May affect reproduction In males, it may inhibit sperm production In women, it may block ovulation Comer, Abnormal Psychology, 7e

Cannabis Cannabis and Society: A Rocky Road For centuries, cannabis played a respected role in medicine, but its use fell out of favor and was criminalized In the late 1980s, several interest groups campaigned for the medical legalization of marijuana The U.S. Federal Government has continued to fight and punish the production and distribution of marijuana for medical purposes Both the Netherlands and Canada permit its use Comer, Abnormal Psychology, 7e

Combinations of Substances
People often take more than one drug at a time, a pattern called polysubstance use Researchers have examined the ways in which drugs interact with one another, focusing on cross-tolerance and synergistic effects Comer, Abnormal Psychology, 7e

Cross-tolerance Sometimes two or more drugs are so similar in their actions on the brain and body that, as people build a tolerance for one drug, they are simultaneously developing a tolerance for the other (even if they have never taken it) Users displaying this cross-tolerance can reduce the symptoms of withdrawal from one drug by taking the other Example: alcohol and benzodiazepines Comer, Abnormal Psychology, 7e

Synergistic effects When different drugs are in the body at the same time, they may multiply, or potentiate, each other’s effects This combined impact is called a synergistic effect, and is often greater than the sum of the effects of each drug taken alone Comer, Abnormal Psychology, 7e

Synergistic effects One kind of synergistic effect occurs when two or more drugs have similar actions Example: alcohol, barbiturates, benzodiazepines, and opioids All depressants may severely depress the CNS when mixed, leading to death Comer, Abnormal Psychology, 7e

Synergistic effects A different kind of synergistic effect results when drugs have opposite (antagonistic) effects Example: stimulants or cocaine with barbiturates or alcohol May build up lethal levels of the drugs because of metabolic issues (stimulants impede the liver’s processing of barbiturates and alcohol) Comer, Abnormal Psychology, 7e

Each year tens of thousands of people are admitted to hospitals because of polysubstance use May be accidental or intentional As many as 90% of people who use one illegal drug are also using another to some extent Comer, Abnormal Psychology, 7e

What Causes Substance-Related Disorders?
Clinical theorists have developed sociocultural, psychological, and biological explanations for substance abuse and dependence No single explanation has gained broad support Best explanation: a COMBINATION of factors Comer, Abnormal Psychology, 7e

Causes of Substance-Related Disorders: The Sociocultural View
A number of theorists propose that people are more likely to develop patterns of substance abuse or dependence when living in stressful socioeconomic conditions Example: higher rates of unemployment correlate with higher rates of alcohol use Example: people of lower SES have higher rates of substance use in general Comer, Abnormal Psychology, 7e

Causes of Substance-Related Disorders: The Sociocultural View
Other theorists propose that substance abuse and dependence are more likely to appear in families and social environments where substance use is valued or accepted Example: rates of alcohol use varies between cultures Comer, Abnormal Psychology, 7e

Causes of Substance-Related Disorders: The Psychodynamic View
Psychodynamic theorists believe that people who abuse substances have powerful dependency needs that can be traced to their early years Caused by a lack of parental nurturing Some people may develop a “substance abuse personality” as a result Limited research does link early impulsivity to later substance use, but the findings are correlational and researchers cannot presently conclude that any one personality trait or group of traits stands out in substance-related disorders Comer, Abnormal Psychology, 7e

Causes of Substance-Related Disorders: The Cognitive-Behavioral Views
According to behaviorists, operant conditioning may play a key role in the development and maintenance of substance abuse They argue that the temporary reduction of tension produced by a drug has a rewarding effect, thus increasing the likelihood that the user will seek this reaction again Similarly, the rewarding effects may also lead users to try higher doses or more powerful methods of ingestion Comer, Abnormal Psychology, 7e

Cognitive theorists further argue that such rewards eventually produce an expectancy that substances will be rewarding, and this expectation is sufficient to motivate individuals to increase drug use at times of tension Comer, Abnormal Psychology, 7e

In support of these views, studies have found that many subjects do in fact drink more alcohol or seek heroin when they feel tense In a manner of speaking, this model is arguing a “self-medication” hypothesis Comer, Abnormal Psychology, 7e

If true, one would expect higher rates of substance use among people with psychological symptoms More than 22% of all adults who suffer from psychological disorders have been dependent on or abused alcohol or other substances within the past year Comer, Abnormal Psychology, 7e

Not all drug users find drugs pleasurable or reinforcing when they first take them So why do users keep taking drugs? Comer, Abnormal Psychology, 7e

Some theorists cite Solomon’s opponent-process theory: The brain is structured such that pleasurable emotions inevitably lead to opponent processes – negative aftereffects – that leave the person feeling worse than usual The opponent processes eventually dominate, and avoidance of the negative aftereffects replaces pursuit of pleasure as the primary factor in drug taking Although a highly regarded theory, the opponent-process explanation has not received systematic research support Comer, Abnormal Psychology, 7e

Other behaviorists have proposed that classical conditioning may play a role in drug abuse, dependence, and withdrawal Objects present at the time drugs are taken may act as classically conditioned stimuli and come to produce some of the pleasure brought on by the drugs themselves Although classical conditioning may be at work, it has not received widespread research support as the key factor in such patterns Comer, Abnormal Psychology, 7e

Causes of Substance-Related Disorders: The Biological View
In recent years, researchers have come to suspect that drug misuse may have biological causes Studies on genetic predisposition and specific biochemical processes have provided some support for this model Comer, Abnormal Psychology, 7e

Genetic predisposition Research with “alcohol-preferring” animals has demonstrated that their offspring have similar alcohol preferences Similarly, research with human twins has suggested that people may inherit a predisposition to abuse substances Concordance rates in identical (MZ) twins: 54% Concordance rates in fraternal (DZ) twins: 28% Comer, Abnormal Psychology, 7e

Genetic predisposition Stronger support for a genetic model may come from adoption studies Studies compared adoptees whose biological parents were dependent on alcohol with adoptees whose biological parents were not dependent By adulthood, those whose biological parents were dependent showed higher rates of alcohol use themselves Comer, Abnormal Psychology, 7e

Genetic predisposition Genetic linkage strategies and molecular biology techniques have also provided direct evidence in support of this hypothesis An abnormal form of the dopamine-2 (D2) receptor gene was found in the majority of subjects with alcohol dependence, but in less than 20% of nondependent subjects Comer, Abnormal Psychology, 7e

Biochemical factors Over the past few decades, investigators have pieced together a general biological understanding of drug tolerance and withdrawal Based on NT functioning in the brain The specific NTs affected depend on which drug is used Recent brain imaging studies have suggested that many (perhaps all) drugs eventually activate a single “reward center” or “pleasure pathway” in the brain Comer, Abnormal Psychology, 7e

Biochemical factors The reward center apparently extends from the ventral tegmental area of the brain to the nucleus accumbens and on to the frontal cortex The key NT appears to be dopamine When dopamine is activated at this reward center, a person experiences pleasure Certain drugs stimulate the reward center directly Examples: cocaine, amphetamines, caffeine Other drugs stimulate the reward center in roundabout ways Examples: alcohol, opioids, marijuana Comer, Abnormal Psychology, 7e

Biochemical factors Theorists suspect that people who abuse substances suffer from a reward-deficiency syndrome Their reward center is not readily activated by “normal” life events so they turn to drugs to stimulate this pleasure pathway, particularly in times of stress Defects in D2 receptors have been cited as a possible cause Comer, Abnormal Psychology, 7e

How Are Substance-Related Disorders Treated?
Many approaches have been used to treat substance-related disorders, including psychodynamic, behavioral, cognitive-behavioral, and biological, along with sociocultural therapies Although these treatments sometimes meet with great success, more often they are only moderately helpful Today treatments are typically used in combination on both an outpatient and inpatient basis Comer, Abnormal Psychology, 7e

Psychodynamic Therapies
Psychodynamic therapists try to help those with substance-related disorders become aware of and correct underlying psychological needs and conflicts Research has not found this model to be very effective Tends to be of greater help when combined with other approaches in a multidimensional treatment program Comer, Abnormal Psychology, 7e

Behavioral Therapies A widely used behavioral treatment is aversion therapy, an approach based on classical conditioning principles Individuals are repeatedly presented with an unpleasant stimulus at the very moment they are taking a drug After repeated pairings, they are expected to react negatively to the substance itself and to lose their craving for it Comer, Abnormal Psychology, 7e

Behavioral Therapies Aversion therapy is most commonly applied to alcohol abuse/dependence Covert sensitization is another version of this approach Requires people with alcoholism to imagine extremely upsetting, repulsive, or frightening scenes while they are drinking The pairing is expected to produce negative responses to liquor itself Comer, Abnormal Psychology, 7e

Behavioral Therapies A behavioral approach that has been successful in the short-term is contingency management This procedure makes incentives contingent on the submission of drug-free urine specimens Comer, Abnormal Psychology, 7e

Behavioral Therapies Behavioral interventions are of limited success when used alone They work best when used in combination with either biological or cognitive approaches Comer, Abnormal Psychology, 7e

Cognitive-Behavioral Therapies
Two popular combined approaches, both applied particularly to alcohol use: Behavioral self-control training (BSCT) Clients keep track of their own use and triggers Learn coping strategies for such events Learn to set limits on drinking Learn skills (relaxation, coping, problem-solving) Relapse-prevention training Clients are taught to plan ahead for drinking situations Used particularly to treat alcohol use; also used to treat cocaine and marijuana abuse Comer, Abnormal Psychology, 7e

Biological Treatments
Biological treatments may be used to help people withdraw from substances, abstain from them, or simply maintain their level of use without further increases These approaches have limited long-term success when used alone, but can be helpful when combined with other approaches Comer, Abnormal Psychology, 7e

Detoxification Systematic and medically supervised withdrawal from a drug Can be outpatient or inpatient Two strategies: Gradual withdrawal by tapering doses of the substance Induce withdrawal but give additional medication to block symptoms Comer, Abnormal Psychology, 7e

Detoxification Detoxification programs seem to help motivated people withdraw from drugs For people who fail to receive psychotherapy after withdrawal, however, relapse rates tend to be high Comer, Abnormal Psychology, 7e

Antagonist drugs An aid to resist falling back into a pattern of substance abuse or dependence, antagonist drugs block or change the effects of the addictive substance Example: disulfiram (Antabuse) for alcohol Example: naltrexone for narcotics, alcohol Comer, Abnormal Psychology, 7e

Drug maintenance therapy A drug-related lifestyle may be a greater problem than the drug’s direct effects Example: heroin addiction Thus, methadone maintenance programs are designed to provide a safe substitute for heroin Methadone is a laboratory opioid with a long half-life, taken orally once a day Programs were roundly criticized as “substituting addictions” but are regaining popularity, partly because of the spread of HIV/AIDS Comer, Abnormal Psychology, 7e

Sociocultural Therapies
Three main sociocultural approaches to substance-related disorders: Self-help and residential treatment programs Culture- and gender-sensitive programs Community prevention programs Comer, Abnormal Psychology, 7e

Self-help and residential treatment programs Most common: Alcoholics Anonymous (AA) Offers peer support along with moral and spiritual guidelines to help people overcome alcoholism Many self-help programs have expanded into residential treatment centers or therapeutic communities People formerly dependent on drugs live, work, and socialize in a drug-free environment while undergoing individual, group, and family therapies Comer, Abnormal Psychology, 7e

Culture- and gender-sensitive programs A growing number of treatment programs try to be sensitive to the special sociocultural pressures and problems faced by drug abusers who are poor, homeless, or members of ethnic minority groups Similarly, therapists have begun to focus on the unique issues facing female substance users Comer, Abnormal Psychology, 7e

Community prevention programs Perhaps the most effective approach to substance-related disorders is to prevent them Some prevention programs argue for total abstinence from drugs, while others teach responsible use Prevention programs may focus on the individual, the family, the peer group, the school, or the community at large The most effective of these prevention efforts focuses on multiple areas to provide a consistent message about drug use in all areas of life Comer, Abnormal Psychology, 7e

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